JP5875991B2 - Outer sheath and blade arrangement for ultrasonic surgical instruments - Google Patents

Description

  The present disclosure relates generally to ultrasound surgical systems, and more specifically to ultrasound systems that allow a surgeon to perform tissue cutting and coagulation.

  Over the years, various different types of non-ultrasonic driven cutters and cutting devices have been developed for performing surgical procedures. Some of these devices employ rotary cutting instruments and other devices employ reciprocating cutting members. For example, shavers are widely used in arthroscopic surgery. Arthroscopic surgery involves performing surgery within the joint cavity. In order to perform the surgery, the joint is typically filled with pressurized saline for expansion and visualization.

  Such devices are generally comprised of a power supply, a handpiece, and a disposable end effector. The end effector generally has inner and outer tubes. The inner tube rotates relative to the outer tube and cuts tissue at its sharp edges. The inner tube can be continuously rotated or vibrated. In addition, such devices may employ suction channels that run through the interior of the inner tube. For example, U.S. Pat. No. 4,970,354 to McGurk-Burson et al. Discloses a non-ultrasonically driven surgical cutting instrument that includes a rotating cutter for cutting material using shearing action. This employs an inner cutting member that is rotatable within the outer tube.

  US Pat. No. 3,776,238 to Peyma et al. Describes an ophthalmic device in which tissue is cut by the shredding action produced by the sharp end of the inner tube that moves relative to the inner surface of the end of the outer tube. Disclose. U.S. Pat. No. 5,226,910 to Kajiyama et al. Discloses another surgical cutting instrument having an inner member that moves relative to the outer member to cut tissue entering through an opening in the outer member. To do.

  Wuchinich et al., US Pat. No. 4,922,902, discloses a method and apparatus for endoscopic removal of tissue utilizing an ultrasonic inhaler. The device uses an ultrasonic probe that collapses soft tissue and inhales it through a narrow orifice. Spinosa et al., US Pat. No. 4,634,420, discloses an apparatus and method for removing tissue from an animal, including an elongated instrument having a needle or probe that is vibrated laterally at an ultrasonic frequency. The ultrasonic movement of the needle breaks the tissue into pieces. Tissue debris can be removed from the treatment area by inhalation through a conduit in the needle. Banko U.S. Pat. No. 3,805,787 discloses yet another ultrasonic instrument having a probe that is shielded to narrow the beam of ultrasonic energy emitted from the tip of the probe. In one embodiment, a shield extends beyond the free end of the probe to prevent the probe from contacting tissue. Davis U.S. Pat. No. 5,213,569 discloses a phacoemulsification needle that focuses ultrasonic energy. The focusing surface can be inclined, curved, or faceted. Wuchinich U.S. Patent No. 6,984,220 and Easley U.S. Patent Publication No. 2005/0177184 provide ultrasonic tissue that provides a combination of longitudinal and torsional motion through the use of longitudinal-twisted resonators. A dissection system is disclosed. US Patent Publication No. 2006/0030797 A1 to Zhou et al. Discloses an orthopedic surgical device having a drive motor for driving an ultrasonic transducer and a horn. An adapter is provided between the drive motor and the transducer to provide an ultrasonic energy signal to the transducer.

  The use of ultrasonically driven surgical instruments offers several advantages over conventional mechanically driven saws, drills, and other instruments, while in bone and adjacent tissues due to frictional heat at the bone / tissue interface. The temperature rise of can still be a serious problem. Current arthroscopic surgical tools include a punch, a reciprocating shaver, and a radio frequency (RF) device. Mechanical devices such as punchers and shavers cause minimal tissue damage, but sometimes can leave undesirable uneven cutting lines. RF devices can provide a smoother cutting line and can cauterize large volumes of soft tissue, however, they tend to cause more tissue damage than mechanical means. Accordingly, it may be desirable to have a device that can provide improved cutting accuracy while forming a smooth cut surface without causing excessive tissue damage.

  The above discussion is intended only to illustrate the current field and should not be construed as denying the scope of the claims.

  In various embodiments, a surgical instrument is provided. In at least one embodiment, the surgical instrument includes a hollow sheath including an opening, a blade disposed at least partially within the hollow sheath and extending through the opening, and at least operatively coupled to the blade. One ultrasonic transducer can be included. In these embodiments, the hollow sheath can define a longitudinal axis and the blade can comprise a tip and a cross-sectional shape that is a polygon adjacent to the tip. Further, in these embodiments, the tip can protrude away from the longitudinal axis.

  In at least one embodiment, a surgical instrument is provided that can comprise a blade defining a longitudinal axis, a suction port, and at least one ultrasonic transducer operably coupled to the blade. In these embodiments, the blade comprises a distal end, a lumen, a first opening adjacent to the distal end, and a first cutting edge positioned above the first opening. be able to. Further, in these embodiments, the first opening can be in communication with the lumen. In addition, the first cutting edge can protrude away from the longitudinal axis. Further, in these embodiments, the blade is configured such that suction can be applied from the suction port to the first opening.

  In at least one embodiment, a surgical instrument is provided that can comprise a blade defining a longitudinal axis, a suction port, and at least one ultrasonic transducer operably coupled to the blade. In these embodiments, the blade includes a distal end, a lumen, a first opening, a first cutting edge positioned above the first opening, and a second opening. And a second cutting edge positioned above the second opening. Further, in these embodiments, the first opening and the second opening can be in communication with the lumen. In addition, the first cutting edge and the second cutting edge can project away from the longitudinal axis, and the second cutting edge can be proximal to the first cutting edge. . Further, in these embodiments, the blade is configured such that suction can be applied from the suction port to the first opening.

The novel features of the embodiments described herein are set forth with particularity in the appended claims. These embodiments, however, can be better understood with reference to the following description, considered in conjunction with the accompanying drawings below, for any of the organization and operation methods.
1 is a schematic diagram of a non-limiting embodiment of a surgical control system embodiment. FIG. 1 is a partial cross-sectional view of a non-limiting embodiment of a hand-held surgical instrument that employs a blade and a hollow sheath. FIG. FIG. 3 is a perspective view of a distal portion of the surgical instrument of FIG. FIG. 3 is a cross-sectional view of the distal portion of the surgical instrument of FIG. 2 taken along line 3A-3A of FIG. FIG. 3 is a perspective view of an alternative embodiment of the distal portion of the surgical instrument of FIG. FIG. 3 is a perspective view of another alternative embodiment of the distal portion of the surgical instrument of FIG. FIG. 3 is a side view of a distal portion of the blade of the surgical instrument of FIG. 2. FIG. 7 is a cross-sectional view of the blade of FIG. 6 taken along line 6A-6A, with the parallel line pattern omitted for clarity. FIG. 3 is a partial cross-sectional view of a non-limiting embodiment of a hand-held surgical instrument that employs a blade with suction applied thereto. FIG. 8 is a perspective view of a distal portion of the surgical instrument of FIG. FIG. 8 is a front view of a distal portion of the surgical instrument of FIG. FIG. 8 is a side cross-sectional view of the distal portion of the blade of the surgical instrument of FIG. 7, showing the blade for cutting tissue to result in a piece of tissue that is subsequently ejected proximally by aspiration. FIG. 8 is a perspective view of the distal portion of the blade of the surgical instrument of FIG. 7, showing the blade oscillating with ultrasonic motion. FIG. 8 illustrates the use of the surgical instrument of FIG. 7 in connection with performing a discectomy. 8 depicts a further use of the surgical instrument of FIG. 7 in connection with performing a discectomy. FIG. 8 is a perspective view of an alternative embodiment of the distal portion of the blade of the surgical instrument of FIG. FIG. 13 is a front view of a distal portion of the blade of FIG. FIG. 8 is a perspective view of another alternative embodiment of the distal portion of the blade of the surgical instrument of FIG. FIG. 15 is a front view of a distal portion of the blade of FIG. FIG. 15 is a side cross-sectional view of the distal portion of the blade of FIG. 14 showing the blade cutting tissue to result in a piece of tissue that is subsequently ejected proximally by suction.

The owner of this application also owns the following US patent applications, filed on the same date, each of which is incorporated herein by reference in its entirety:
Name “ULTRASONICLY POWERED SURGICAL INSTRUMENTS WITH ROTATING CUTTING IMPLEMENT”, US Patent Application No. _____
Name "METHODS OF USING ULTRASONICALLY POWERED SURGICAL INSTRUMENTS WITH ROTATABLE CUTING IMPLEMENTS", agent number END6689USNP / 090342, US Patent Application No. _____
Name “SEAL ARRANGEMENTS FOR ULTRASONICALLY POWERED SURGICAL INSTRUMENTS”, United States Patent Application No. ______________, END6690USNP / 090343
Name "ULTRASONIC SURGICAL INSTRUMENTS WITH ROTATABLE BLADE AND HOLLOW SHEATH ARRANGEMENTS", US Patent Application No. _____________, ENT6691USNP / 090344,
Name "ROTATABLE CUTING IMPLEMENT ARRANGEMENTS FOR ULTRASONIC SURGICAL INSTRUMENTS", United States Patent Application No. _____________, ENT6692USNP / 090345
Name "ULTRASONIC SURGICAL INSTRUMENTS WITH PARTIALLY ROTATING BLADE AND FIXED PAD ARRANGEMENT", US Patent Application No. END6693USNP / 090346, _____,
Name “DUAL PURPOSE SURGICAL INSTRUMENT FOR CUTTING AND COAGULATING TISSUE”, US Patent Application No.
Entitled "ULTRASONIC SURGICAL INSTRUMENTS WITH MOVING CUTTING IMPLEMENT", U.S. Patent Application Serial No. _____ No. Attorney Docket No. END6687USNP / 090349, and entitled "ULTRASONIC SURGICAL INSTRUMENT WITH COMB-LIKE TISSUE TRIMMING DEVICE", US Attorney Docket No. END6686USNP / 090367 Patent application _____.

  In order to provide a comprehensive understanding of the principles of structure, function, manufacture, and use of the devices and methods disclosed herein, specific embodiments are described hereinafter. One or more examples of these embodiments are illustrated in the accompanying drawings. The devices and methods described in detail herein and shown in the accompanying drawings are non-limiting embodiments, and the scope of these embodiments is defined only by the claims. Those skilled in the art will appreciate. Features shown or described in connection with one embodiment may be combined with features of other embodiments. Further, where ordering of steps within a method is noted, such ordering may be reordered unless it is unreasonable or unless the order stated is clearly required, or The steps may be performed simultaneously as necessary. Such modifications and variations are intended to be included within the scope of the appended claims.

  In the following description, like reference characters designate like or corresponding parts across multiple views. In the following explanation, “front”, “back”, “front”, “back”, “right”, “left”, “upward”, “downward”, “upper”, “lower”, “upward” It is understood that terms such as “downward”, “proximal”, “distal”, etc. are terms for convenience and should not be construed as limiting the terms. The following description is for the purpose of illustrating various embodiments and is not intended to limit the scope of the appended claims.

  Various embodiments are directed to improved ultrasonic surgical systems and instruments and cutting tools employed thereby configured to cause tissue dissection, cutting, and / or coagulation during a surgical procedure. In one embodiment, the ultrasonic surgical instrument device is configured for use in an open surgical procedure, but also has applications in other types of surgery such as laparoscopes, endoscopes, and robot-assisted procedures. Multipurpose use is facilitated by selective use of ultrasonic energy and / or suction applied in the vicinity of and / or through the cutting / coagulation tool.

  It will be appreciated that the terms “proximal” and “distal” are used herein with reference to the clinician gripping the handpiece assembly. Thus, for example, an end effector that includes a cutting / coagulation tool is distal to a more proximal handpiece assembly. Furthermore, for convenience and clarity, terms relating to space such as “upper” and “lower” are also used herein with reference to the clinician holding the handpiece assembly. However, surgical instruments are used in many orientations and arrangements, and these terms are not intended to be limiting and absolute.

  FIG. 1 illustrates in schematic form one embodiment of a surgical system 10 of the present invention. The surgical system 10 may include an ultrasonic generator 12 and an ultrasonic surgical instrument assembly 100 that may include an ultrasonic generation component. As described in more detail below, the ultrasound generator 12 may be connected by a cable 14 to an ultrasound transducer assembly 114 within the housing portion 102 of the surgical instrument assembly 100. The transducer assembly 114 may include one or more ultrasonic transducers that can generate ultrasonic vibrations. Further, a horn 124 may be attached to the ultrasonic transducer assembly 114 to amplify and / or focus the ultrasonic motion provided by the transducer assembly 114. Coupled to the horn 124 is a blade 200 disposed at least partially within the outer hollow sheath 230 and extending from the housing portion 102. In at least one embodiment, the horn 124 and the blade 200 are unitary and may be integrally formed from the same piece of material. In another embodiment, the horn 124 and the blade 200 may be separate components that are attached together.

  In various embodiments, the ultrasonic generator 12 may include an ultrasonic generator module 13 and a signal generator module 15. Please refer to FIG. Each of the ultrasonic generator module 13 and / or the signal generator module 15 may be integrated with the ultrasonic generator 12 or provided as a separate circuit module electrically coupled to the ultrasonic generator 12. (Shown with a dotted line to illustrate this option). In one embodiment, the signal generator module 15 may be formed integrally with the ultrasonic generator module 13. The ultrasonic generator 12 may include an input device 17 located on the front panel of the generator 12 console. Input device 17 may include any suitable device that generates signals suitable for programming the operation of generator 12 in a known manner. Still referring to FIG. 1, as will be described in further detail below, the cable 14 may be used to apply electrical energy to the positive (+) and negative (−) poles of the ultrasonic transducer assembly 114. A plurality of conductors such as lines may be included.

  Various forms of ultrasonic generators, ultrasonic generator modules, and signal generator modules are known. For example, such a device is commonly owned U.S. patent application filed Jul. 15, 2007, entitled "Rotating Transducer Mount For Ultrasonic Surgical Instruments", which is incorporated herein by reference in its entirety. 12 / 503,770. Other such devices include the following U.S. Patents, U.S. Patent No. 6,480,796 (Method for Improving the Start Up of Ultrasonic System Under Zero Load Conditions), U.S. Patent No. 6,537,291 (th. for Detection a Loose Blade in a Handle Connected to an Ultrasonic Surgical System, US Pat. No. 6,626,926 (Method for Driving the Ultrascientific Sequential Science) p), U.S. Pat. No. 6,633,234 (Method for Detecting Blade Breaking Using Rate and / or Impedance Information), U.S. Pat. No. 6,662,127 (Method for Detection Presence of a B) US Pat. No. 6,678,621 (Output Displacement Control Using Phase Margin in an Ultrasonic Surgical Handle), US Pat. onic Handle), U.S. Patent No. 6,908,472 (Apparatus and Method for Altering Generator Functions in an Ultrasonic Surgical System, U.S. Patent No. 6,977,495 (Detection Cig). , 077,853 (Method for Calculating Transducer Capacitance to Determinant Transducer Temperature), US Pat. No. 7,179,271 (Method for Driving an Ultra Sty. Prospect Acquisition of Blade Resonance Frequency at Startup and U.S. Pat. No. 7,273,483 (Apparatus and Method for Alerting Generator on Situation) All of which are incorporated herein by reference.

  As can be seen in FIG. 2, the ultrasonic surgical instrument 100 may include a housing 102 that houses an ultrasonic transducer assembly 114 and a horn 124. Transducer assembly 114 may be fixedly supported within housing 102 by fixture 104. A blade 200 that passes through the hollow sheath 230 and exits into a window or opening 231 defined therein may extend from the horn 124. As shown in FIG. 2, the distal tip 202 of the blade 200 may be visible through the opening 231 in the distal portion 250 of the surgical instrument 100. The blade tip 202 and / or the distal portion 250 of the surgical instrument 100 may be considered an “end effector” of the instrument 100. As will be described in greater detail below, the blade 200 allows the instrument to be proximal to the tissue in a proximal direction “PD” or distal direction “parallel to or coaxial with the longitudinal axis AA of the hollow sheath. The tissue may be cut when moved in the “DD”, perpendicular direction, or any direction therebetween. The housing 102 may be provided with two or more components attached together by fasteners such as screws, snap features and / or by one or more adhesives, such as polycarbonate, stainless steel, Alternatively, it may be processed from other materials.

  Still referring to FIG. 2, the ultrasonic transducer assembly 114 includes a housing 118 that supports the piezoelectric ultrasonic transducer 115 for converting electrical energy into mechanical energy that provides longitudinal oscillating motion of the ends of the transducer 115. But you can. The ultrasonic transducer 115 includes a stack of ceramic piezoelectric elements and may be accompanied by a motion null point located at a point along the stack. The ultrasonic transducer 115 may be implemented between the proximal end piece 116 and the distal end piece 117. In addition, the horn 124 may be mounted on the distal end component 117 at a null point on one side and mounted on the blade 200 on the opposite side. As a result, the blade 200 oscillates longitudinally at an ultrasonic frequency rate with the ultrasonic transducer assembly 114. When the ultrasonic transducer assembly 114 is driven at the transducer's resonant frequency at maximum current, the end of the ultrasonic transducer assembly 114 achieves maximum motion and a portion of the stack constitutes a stationary node. However, the current providing maximum movement is different for each instrument and is the value stored in the instrument's non-volatile memory so that the system can use it.

  The components of surgical instrument 100 may be designed so that the combination vibrates at the same resonant frequency. Specifically, the elements may be adjusted so that the resulting length of each such element is a half wavelength or a plurality thereof. Longitudinal back and forth motion is amplified as the diameter closer to the blade 200 of the acoustic mounting horn 124 decreases. Accordingly, the horn 124 and the blade 200 are super-resonant with other parts of the acoustic system that amplify the blade motion and produce the maximum back and forth movement of the end of the acoustic mounting horn 124 close to the blade 200. It may be shaped and dimensioned to provide sonic vibration. The 20-25 micrometer motion at the ultrasonic transducer 115 may be amplified by the horns 124 to a blade movement of about 40-100 micrometers.

  Returning briefly to FIG. 1, when a voltage is applied to the ultrasonic instrument 110 by the switch arrangement, the ultrasonic generator 12 may cause the blade 200 to vibrate in the longitudinal direction at about 55.5 kHz, for example. Often, the amount of longitudinal movement varies in proportion to the amount of drive power (current) applied so that it can be adjusted by the user. The blade 200 may be designed to move longitudinally within a range of about 40-100 micrometers at an ultrasonic vibration speed when a relatively high cutting power is applied. Such ultrasonic vibration of the blade 200 generates heat when the blade contacts the tissue, i.e., the blade 200 moving through the tissue is very narrow and within a limited range. 200 mechanical energy is converted into thermal energy. This local heat results in narrow area clotting, which reduces or eliminates bleeding in small blood vessels, such as those less than 1 millimeter in diameter. The cutting efficiency of the blade 200 and the degree of hemostasis depend on the level of drive power applied, the cutting speed or force applied to the blade by the surgeon, the nature of the tissue type, and the vascular distribution of the tissue.

  Referring again to FIG. 2, surgical instrument 100, and thus blade 200, may be globally moved by the user relative to the tissue to be cut. As used herein, terms such as “global motion” are distinguished from “ultrasonic motion” or the like that can be achieved by the method of an ultrasonic transducer assembly. Instead, the term “global motion” encompasses parallel and rotational motions that are not simply generated by the operation of the ultrasonic transducer assembly 114.

  To provide power to the ultrasonic instrument 110 from the ultrasonic generator 12 (see FIG. 1), a protector 110 with a flexible wire tray or multiple segments joined may be employed. As can be seen in FIG. 2, conductors 151, 152 are coupled to the ultrasonic transducer assembly 114 and extend out of the instrument through the housing 102. Further, the protector 110 may be attached to the instrument housing 102 at one end and attached to the transducer assembly housing 118 at the other end. The conductors 151, 152 may pass through one or more holes in the transducer assembly housing. Therefore, the ultrasonic signal from the ultrasonic generator 12 is transmitted to the ultrasonic transducer 115 through the conductors 151 and 152. The protector 110 may prevent the conductors 151, 152 from being damaged or pinched in the housing 102, for example, when the instrument 100 is manufactured.

  Still referring to FIG. 2, the various embodiments also include a distal nosepiece 160 that may be removably attached to the distal end of the housing 102 by fasteners and / or adhesives (not shown). Including. The nosepiece 160 may be fabricated from, for example, stainless steel, aluminum, or plastic. In various embodiments, the distal end 202 of the blade 200 extends through the hollow portion 210 of the nosepiece 160. The hollow sheath 230 may extend through the hollow portion 210 as well. The hollow portion 210 may include an annular groove in which the end of the hollow sheath 230 and the proximal seal 212 to the blade 200 may be retained. The seal 212 includes, for example, a silicone O-ring and / or a brazed or press-fit seal, and a substantially fluid and / or gas tight seal between the nosepiece 160, the blade 200, and the hollow sheath 230. It may work to establish.

  Also, in various embodiments, the hollow sheath 230 is aligned coaxially with the blade 200 and includes, for example, nosepiece 160, such as by welding, press fitting, screwing, gluing or gluing with other adhesive (s). May be attached to the hollow portion 210 of the. As can be seen in FIG. 2, the suction port 240 may be attached to the nosepiece 160 so as to communicate with the proximal hole 232 in the hollow sheath 230. The flexible tube 242 may be in communication with a collection vessel 243 attached to the suction port 240 and connected to a vacuum source generally depicted as 244. Thus, the hollow sheath 230 forms a suction path that extends around the blade 200 starting at the distal portion 250 of the outer sheath 230 such as the opening 231 and exiting through the hole 232 to the suction port 240. One skilled in the art will appreciate that alternative suction paths are also possible. Further, the suction path from the opening 231 through the sheath 230, out of the hole 232, and through the port 240 is maintained with or without minimal entry of air from outside the aforementioned path. As with the proximal seal 212, the distal seal 213 may be retained within the nosepiece 160 and may facilitate further sealing of the hollow sheath 230 therein. Alternatively, the suction port may be omitted from the nosepiece and the surgical instrument may operate without applying suction to the opening 231.

  Various embodiments of the surgical system 10 (see FIG. 1) provide the ability to selectively apply ultrasonic axial motion to the blade 200. If desired, the clinician may activate the ultrasonic transducer assembly 114 before or while cutting tissue with the blade 200. The frequency range of the longitudinal ultrasonic motion may be, for example, about 30-80 kHz. Similarly, the clinician may wish to move the instrument 100 and thus the blade 200 without actuating the ultrasonic transducer assembly 114. Accordingly, global motion may be applied to the blade 200 without applying longitudinal ultrasonic motion. In other applications, the clinician may wish to use the instrument 100 by both actuating the ultrasonic transducer assembly 114 and globally moving the blade 200 relative to the tissue to be cut. is there. In such embodiments, the blade 200 experiences longitudinal ultrasonic movement from the transducer assembly 114 and global movement from the clinician movement. Further, those skilled in the art will readily appreciate that various embodiments of the surgical system 10 may be employed to work in connection with arthroscopic and other surgical applications.

  Surgical instrument 100 may have various distal portions. 3 and 3A illustrate an example of a distal portion 250 of a non-limiting embodiment of a surgical instrument, similar numbers previously used to describe the various embodiments disclosed above are Used to specify similar components. FIG. 3 is a perspective view of the distal portion 250 of the surgical instrument and FIG. 3A is a cross-sectional view of the distal portion 250 taken along line 3A-3A of FIG. In these embodiments, the surgical instrument includes a thin hollow sheath 230 that includes an opening 231, a blade 200 that is disposed at least partially within the hollow sheath 230 and extends through the opening 231, and the blade 200. And at least one ultrasonic transducer (not shown, see transducer 115 in FIG. 2) operably coupled.

As can be seen in FIGS. 3 and 3A, in various embodiments, the blade 200 has a distal tip 202 that protrudes away from the longitudinal axis AA of the sheath to facilitate tissue cutting. May be included. More specifically, the distal tip 202 may be the distance L ₁ projecting from the longitudinal axis A-A of the hollow sheath. The distance L ₁ may be a distance large enough to improve the cutting effectiveness of the blade. In at least one embodiment, L ₁ may be at least 0.25 inches. In another embodiment, L ₁ may be 0.75 inches or less. In yet another embodiment, L ₁ is between 0.25 inch and 1.905 cm (0.75 inches), including 0.635 cm (0.25 inch) and 1.905 cm (0.75 inch). Inch), in other words, 0.635 cm ≦ L ₁ ≦ 1.905 cm (¼ inch ≦ L ₁ ≦ 3/4 inch).

  Further, the hollow sheath may be configured to expose various portions of the blade 200 to further facilitate tissue cutting in various situations. For example, still referring to FIG. 3, in at least one embodiment, the sheath opening 231 may define a plane that intersects the longitudinal axis AA and is not perpendicular to the longitudinal axis. As used herein, the term “perpendicular” means perpendicular to the longitudinal axis. In other words, the opening 231 is at an angle with respect to the longitudinal axis, thereby exposing the blade only on one side 215 of the hollow sheath 230. In such embodiments, the back side 215 of the blade, which is the side 215 opposite to the direction in which the blade tip 202 projects, is shielded by the sheath 230 so that tissue is not accidentally cut on that side 215. May be. In addition, as described above, the sheath 230 may be thin and configured to be overcoated on the blade 230. In such embodiments, the clearance between the blade 200 and the sheath 230 (see FIG. 3A) may be minimized.

Alternatively, referring now to FIG. 4, in at least one embodiment, the hollow sheath 330 of the distal portion 350 of the surgical instrument allows the blade 200 to protrude therethrough while cutting tissue. An opening 331 that exposes the back side 215 of the blade 200 may be included to increase the available cutting planes and / or edges. In such an embodiment, the opening 331 may define a _first plane P ₁ and a second plane P ₂ that intersects the first plane, and the blade is in the first plane P _1. May extend through. The first plane P ₁ may be perpendicular to the longitudinal axis A-A, when the second plane P ₂ intersects the first planar P _1, the plane P ₂ of the second, the It may be at an angle with respect to the first plane.

  In another alternative embodiment, the hollow sheath 450 of the surgical instrument distal portion 450 may include a protective lip 433 that allows the blade 200 to be further protected from accidentally cutting tissue. More particularly, the blade may extend through the opening 431, but it may still be desirable to prevent tissue from being cut on the back side 215 of the blade. Thus, the protective lip 433 may extend toward the tip 202 and away from the longitudinal axis A-A, thereby shielding, for example, the larger portion of the blade 200 shown in FIG. .

  In various embodiments, referring now to FIGS. 6 and 6A, the blade 200 may include various features that enhance its cutting and / or coagulation capabilities. More particularly, FIG. 6 is a side view of the distal portion of the blade 200, and FIG. 6A is a cross-sectional view of the blade 200 taken along line 6A-6A. Note that in FIG. 6A, the parallel line pattern is omitted for clarity. In at least one embodiment, the blade 200 may be curved adjacent to the tip 202, as can be seen in FIG. Returning briefly to FIG. 3, a blade 200 that is curved through the opening 231 can be seen. The curved shape of the blade 200 may allow for a smooth cut to be made along the blade 200 near the tip 202. More specifically, the blade may be curved by a set amount so that the tip protrudes at a specific angle with respect to the axis AA of the hollow shaft (see FIG. 3). Turning attention to FIG. 6, the blade 200 may define a first axis A'-A '. As can be seen in FIG. 3A, within the hollow shaft, the first axis A′-A ′ may be collinear with or parallel to the axis AA of the hollow shaft. Also good. In any case, referring back to FIG. 6, the blade 200 may also define a second axis BB through the tip 202. The second axis AA may be a curved tangent at or near the tip of the blade. The first and second axes may define an angle θ that is greater than or equal to 60 degrees, but less than or equal to 90 degrees. In other words, 60 ° ≦ θ ≦ 90 °. Such a tip angle may provide an improved cutting function of the blade 200.

  The shape of the tip 202 and / or the cross-section of the blade may further improve the cutting ability of the blade 200. For example, in various embodiments, referring now to FIG. 6A, the blade 200 may increase the number of cut surfaces it presents by employing a cross-sectional shape that is a polygon adjacent to the tip 202. Good. More specifically, in at least one embodiment, the polygonal cross-sectional shape may be a quadrilateral, and even more specifically, may be a rhombus or an equilateral parallelogram. Colloquially, the rhombus shape may be considered a diamond shape. Such a shape is such that the blade is defined between edges 203, 204, 205 and 206, forming part of the cutting edge of the blade as seen in FIG. 6A, vertices 207, 208, 209. , And 210 may be able to be presented. The degree of sharpness of vertices such as vertex 207 may be defined as follows. The angle α defined between the rhombus side such as the side 203 and the rhombus center line such as the center line “CL” is 10 degrees or more, but may be 25 degrees or less. In other words, 10 ° ≦ α ≦ 25 °. By employing such sharp edges defined by the shape of the rhombus apex, the need to polish blade 200 may be reduced.

In addition, the cross-sectional shape of the blade may allow the blade to operate better in such an environment with reduced resistance through aqueous or other fluids. For example, in at least one embodiment, the diamond shape in cross section may be longer in one direction and shorter in the other direction. More specifically, the diamond shape may be generally longer in the proximal direction PD and the distal direction DD, respectively. Specifically, two of the rhombus vertices, vertices 207 and 209, are also co-planar with the longitudinal axis of the blade (see FIG. 3A), axis CC (see FIG. 6A). It may be defined. Thus, the resistance experienced by the blade in the fluid environment is reduced as the blade is moved in the proximal direction PD and the distal direction DD, respectively. Furthermore, the blade, the blade 200 is to have a width _{L 2} to the vertex 210 from the apex 208 of 0.0508 cm (0.020 inches) ～0.1016Cm (0.040 inches), it may be made thinner. In other words, 0.0508 cm ≦ L ₂ ≦ 0.1016 cm (0.020 inch ≦ L ₂ ≦ 0.040 inch). In at least one embodiment, _{L 2} may be a 0.0762 cm (0.030 inches).

  In various embodiments, the tip 202 may also include a polygonal cross-sectional shape that tapers toward a point. For example, in at least one embodiment, referring to FIG. 6, the tip may be in the shape of a pyramid. Thus, both the pointed end of the tip and the pyramidal edge of the tip can contribute to improved cutting points and / or edges.

  In addition, in at least one embodiment, the blade 200 is polygonal, for example, along its entire length or similarly along at least a portion of the blade 200 that is within the hollow sheath 230 (see FIG. 3A). There may be. By using a uniform cross section along at least a portion of the length of the blade, manufacturing costs and resources can be reduced.

  Other blade and / or sheath configurations may be employed by the surgical instrument to achieve improved cutting and / or coagulation within the fluid environment. For example, in various embodiments, the surgical instrument may utilize aspiration to improve the removal of the severed tissue and the severed tissue from the surgical target. More particularly, FIGS. 7-11 illustrate another example of a non-limiting embodiment of a surgical instrument 1100 that was previously used to describe the various embodiments disclosed above. Similarity numbers are used to specify similar components. FIG. 7 is a partial cross-sectional view of a hand-held surgical instrument 1100 that employs a blade 1200 to which suction is applied. The housing 102, transducer assembly 114, horn 124, and related components may be similar to those described above with respect to the surgical instrument 100. At least one ultrasonic transducer, such as transducer 115 in transducer assembly 114, may be operably coupled to blade 1200 by horn 124. The blade 1200 may define a longitudinal axis AA that is similar to the longitudinal axis AA as described above. Further, the blade 1200 may include a body 1201 that defines a lumen 1220 therein and includes a distal end 1202. An opening 1204 that communicates with the lumen 1202 may be adjacent to the distal end 1202. Further, the first cutting edge 1205 may be positioned above the opening 1204. The first cutting edge 1205 may also protrude away from the longitudinal axis A-A to further improve tissue cutting, as will be described in more detail below.

  The surgical instrument 1100 may further include a suction port 240 attached to or formed with the nosepiece 1160. A suction port 240 may be formed in the blade 1200, positioned in the nosepiece 1160, and communicated with the lumen 1220 via a suction hole 1221 aligned with the port 240. The flexible tube 242 may be attached to the suction port 240 and communicate with a collection container 243 connected to a vacuum source 244. Thus, the blade 1200 begins at the distal portion 1250 of the surgical instrument 1100, such as the opening 1204, runs along at least a portion of the lumen 1220, passes through the suction hole 1221 and exits the suction port 240, through the blade 1200. An extended suction path may be formed. One skilled in the art will appreciate that alternative suction paths are also possible. Further, the proximal seal 1212 and the distal seal 1213 may be retained in an annular groove in the nosepiece 1160 around the port 240, through the blade 1200, out of the hole 1221, and through the port 240. Further suction sealing of the blade 1200 therein may be facilitated such that the suction path from 1204 is maintained with or without minimal entry of air from outside the aforementioned path. Accordingly, the blade 1200 is configured such that suction can be applied from the suction port 240 to the opening 1204 as a result.

  In addition, in at least one embodiment, the outer can act as a safety shield that covers at least the cutting edge 1205 and / or the opening 1204 of the blade 1200 when the surgical instrument 1100 is introduced and / or removed from the surgical site. The hollow sheath 1230 may be employed. The retractable hollow sheath 1230 may be movably mounted on the blade 1200 to expose the opening 1204 (see FIG. 8) from a closed position that substantially covers the opening 1204 and / or the cutting edge 1205. It may be selectively movable to the open position. Such an arrangement may cover the cutting edge 1205 and / or opening 1204 on the blade 1200 during insertion and removal of the blade 1200 adjacent to essential nerves and other critical tissue. To facilitate movement of the hollow sheath 1230 on the blade 1200, a thumb control tab 1232 (FIG. 7) is placed on the proximal end of the hollow sheath 1230 so that a clinician can apply a sliding actuation force thereto. May be formed.

  In various embodiments, different blade configurations may be employed to improve the cutting and draining of tissue from the surgical target. Turning now to the distal portion of the surgical instrument 1250 best seen in FIG. 8, the blade may have a tubular shape. Further, a cutting edge 1205 can be seen positioned above the opening 1204 and projecting away from the longitudinal axis AA of the blade. In at least one such embodiment, now turning to the front view of the distal portion 1250 provided by FIG. 9, the cutting edge defining the arc can be seen. Thus, tissue such as intervertebral disc tissue can be cut smoothly and shaped along arcuate cutting edges 1205.

  Further details regarding the blade 1200 can be found by noting FIGS. FIG. 10 shows a side cross-sectional view of the distal portion of blade 1200, and FIG. 11 shows a perspective view of the distal portion of blade 1200. The cutting edge 1205 may be defined by a cutting shroud 1210 that is integrally formed with the blade body 1201 or otherwise attached thereto. As can be seen in FIG. 10, the shroud 1210 and the cutting edge 1205 may protrude away from the longitudinal axis AA to form the body 1201. Furthermore, the cross-sectional shape of the shroud, also seen in FIG. 10 in this case, may protrude at an angle from the body 1201 to better present the cutting edge 1205 to the tissue T. Also, as can be seen in FIG. 10, as described above, the tissue “T” results in a tissue piece “TF” that is subsequently drawn through the opening 1204 by suction and ejected in the proximal direction PD. The cutting edge 1205 of the blade is shown. The tissue may be cut as the blade 1200 is advanced in the distal direction DD so that the cutting edge 1205 embeds itself in the tissue T or otherwise scrapes the surface of the tissue. Alternatively, tissue may be drawn into the cutting edge 1205 by suction applied to the opening 1204. Furthermore, the presence of aspiration can clear the tissue piece TF from the surgical target area, thereby eliminating or reducing the need to repeatedly insert and remove surgical instruments from the patient. In addition, as illustrated in FIG. 11, the blade 1200 may include one or more ultrasonic transducers 115 (FIG. 7) to further improve the ability of the cutting edge to sever and / or cauterize tissue. May be vibrated with the ultrasonic motion provided by

  Returning to FIG. 7, in use, the clinician may activate the vacuum source 244 to cut and drain the tissue. In the face of bleeding, the clinician may actuate the ultrasonic transducer assembly 114 to generate ultrasonic motion on the blade 1200 for coagulation purposes. For example, spinal fusion surgery requires removal of disc material due to various medical conditions. In many cases, this material is hard and requires considerable force with conventional instruments to break the intervertebral disc and remove the fragments. Once the intervertebral disc material has been removed, the end plate must be shaved to reveal a fresh surface in order to promote the fusion of the plate to the cage. The plate must also be shaped to provide a good fit with the type of cage used. Conventional instruments generally require a strong force from the surgeon, very close to the critical structure.

  The use of the surgical instrument 1100 described above may be particularly advantageous, for example, when performing a discectomy, as shown in FIGS. As can be seen in these figures, the blade 1200 may be inserted into the intervertebral disc “D”. The blade 1200 may be used to scrape off small pieces of the intervertebral disc and suck them out. Such an arrangement eliminates the need for repeated insertion / removal of surgical tools. The device may also be employed to prepare a spinal endplate. By incorporating suction through the blade 1200, ultrasonic motion relative to the blade 1200, and / or unique blade configurations, the amount of throwing force that the clinician must provide to prepare the end plate can be reduced. Similarly, the amount of external force required to break and remove the disc material can be reduced. In addition, the number of instrument changes during the surgical procedure can be reduced.

  Surgical instrument 1100 may have various blades from those provided above. For example, FIG. 14 shows a perspective view of an alternative embodiment of a distal portion of a blade 1300 for a surgical instrument 1100 (see FIG. 7), and FIG. 15 shows a front view of the distal portion of the blade 1300. In at least one embodiment, blade 1300 may be similar to blade 1200 described above, except that it may include two or more openings and / or cutting edges that may be advantageously positioned on the blade. More particularly, the blade may define a longitudinal axis A-A, with a distal end 1302, a lumen (not shown, see lumen 1220 in FIG. 7), and distal end 1302. A first opening 1304 that is adjacent and in communication with the lumen may be included. The blade 1300 may include a first cutting edge 1305 that is positioned above the first opening 1304 and projects away from the longitudinal axis AA, similar to the cutting edge 1204 described above. In addition, the blade 1300 also has a second opening 1309 that is also in communication with the lumen and a second cut positioned above the second opening 1309 and projecting away from the longitudinal axis AA. An edge 1306 may also be included. Both the first opening 1304 and the second opening 1309 may be at the same relative longitudinal position along the blade 1200. In other words, both openings 1304, 1309 may be at the same distance from the distal end 1302 along the longitudinal axis AA, however, both openings 1304, 1309 are blades May be at different angular positions along the body 1301.

  The addition of two or more openings can increase the location where the blade 1300 can cut tissue. Accordingly, in at least one embodiment, the blade 1300 may further include a third opening 1307 to further increase the cutting position of the blade. More specifically, the third opening may also communicate with the lumen and be positioned at the same longitudinal position as the other openings 1304, 1309. The third cutting edge 1307 may be positioned above the third opening 1314 and may also protrude away from the longitudinal axis AA. Each cutting edge 1305, 1306, 1307 may be defined by a cutting shroud 1310, 1311, 1312, respectively, which may be similar to shroud 1210 described above. In addition, the openings 1304, 1309, 1314, the cutting edges 1305, 1306, 1307, and / or the shrouds 1310, 1311, 1312 are each symmetrical about the longitudinal axis and positioned equidistant from each other. May be. For example, see FIG.

  Although some of the above embodiments have shown distal cutting edge (s), surgical instrument 1100 may include a blade having proximal cutting edge (s). Good. For example, FIG. 16 shows a perspective view of another alternative embodiment of a distal portion 1400 of a blade 1400 for a surgical instrument 1100 (see FIG. 7), and FIG. 17 is a front view of the distal portion of the blade 1400. FIG. 18 shows a blade 1400 similar to that described above while blade 1400 is cutting tissue T so as to provide a piece of tissue TF that is subsequently ejected proximally by aspiration. FIG. In at least one embodiment, the blade 1400 may be similar to the blade 1200 described above, except that the blade 1400 may include two or more openings and / or cutting edges that may be parallel to each other. Good.

  More particularly, the blade may define a longitudinal axis AA, a first end in communication with the distal end 1402, the lumen 1420, the distal end 1402, and in communication with the lumen 1420. An opening 1404 may be included. The blade 1400 may include a first cutting edge 1405, similar to the cutting edge 1204 described above, positioned above the first opening 1404 and protruding away from the longitudinal axis A-A. Further, the blade 1400 may also include a second opening 1409 that is proximal to the first opening and / or the first cutting edge 1405. The second opening 1409 may also communicate with the lumen 1420. Further, the second cutting edge 1406 may be positioned above the second opening 1409 and protrude away from the longitudinal axis AA. The first opening 1404 and the second opening 1409 may be at different relative longitudinal positions along the blade 1400, but both may be at the same angular position along the body 1401 of the blade. Good. In other words, the openings 1404, 1409 may be on the same side of the blade 1400. In at least one embodiment, the cutting edges 1405, 1406 may be defined by the same cutting shroud 1410. In such an embodiment, the shroud 1410 may be positioned above both openings 1404, 1409.

  Referring to FIG. 18, the blade 1400 has a distal direction DD such that the first distal-facing cutting edge 1405 embeds itself in the tissue T or otherwise scrapes the surface of the tissue. It may be cut when it is advanced. In addition, the tissue is drawn when the blade 1400 is retracted proximally so that the second proximal-facing cutting edge 1406 embeds itself in the tissue T or otherwise scrapes the surface of the tissue. It may be cut into pieces. Alternatively, as described above, tissue may be drawn into one or more of the cutting edges 1405, 1406 by suction applied to the openings 1404, 1409. Furthermore, the presence of aspiration can clear the tissue piece TF from the surgical target area, thereby eliminating or reducing the need to repeatedly insert and remove surgical instruments from the patient. In addition, the blade 1400 provides ultrasonic motion provided by one or more ultrasonic transducers 115 (see FIG. 7) to further improve the ability of the cutting edge to sever and / or cauterize tissue. You may vibrate with.

  The devices described herein can be designed to be discarded after a single use, or they can be designed to be used multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of device disassembly steps, subsequent cleaning steps, or replacement of specific parts, and subsequent reassembly steps. In particular, the device can be disassembled and any number of the particular parts or components of the device can be selectively replaced or removed in any combination. Upon cleaning and / or replacement of particular components, the device can be reassembled for subsequent use upon functional realignment or by the surgical team immediately prior to surgery. One skilled in the art will appreciate that various techniques for disassembly, cleaning / replacement, and reassembly can be used to recondition the device. The use of such techniques and the resulting reconditioned device are all within the scope of this application.

  Preferably, the various embodiments described herein have been processed before surgery. First, a new or used instrument is obtained and cleaned as necessary. The instrument can then be sterilized. In one sterilization method, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK® bag. The container and instrument are then placed in a field of radiation that can penetrate the container, such as gamma rays, x-rays, or high energy electrons. This radiation sterilizes bacteria on the instrument and in the container. The sterilized instrument can then be stored in a sterile container. The sealed container keeps the instrument sterile until it is opened in the medical facility. Sterilization can also be performed by any number of methods known to those skilled in the art, including beta or gamma radiation, ethylene oxide, and / or steam.

  In various embodiments, the ultrasonic surgical instrument can be delivered to the surgeon with the waveguide and / or end effector already operably coupled to the transducer of the surgical instrument. In at least one such embodiment, the surgeon or other clinician removes the ultrasonic surgical instrument from the sterile packaging and inserts the ultrasonic instrument into the generator as outlined above during the surgical procedure. Ultrasonic instruments can be used. Such a system can eliminate the need for a surgeon, or other clinician, to assemble a waveguide and / or end effector to an ultrasonic surgical instrument. After use of the ultrasonic surgical instrument, the surgeon or other clinician can place the ultrasonic instrument in a sealable package, which can be transported to a sterilization facility. In the sterilization facility, the ultrasonic instrument can be sterilized and any used parts can be discarded and replaced, while reusable parts can be sterilized and reused. The ultrasonic instrument can then be reassembled, tested, placed in a sterile package, and / or sterilized after being placed in the package. Once sterilized, the reprocessed ultrasonic surgical instrument can be used again.

  While various embodiments have been described herein, many modifications and variations may be made to these embodiments. For example, different types of end effectors can be employed. Also, although materials have been disclosed for particular components, other materials can be used. The above description and the following “claims” are intended to cover all such modifications and variations.

  Any patent, publication, or other disclosure material that is incorporated by reference in its entirety or in part is incorporated into the existing definition, description, or other disclosure set forth in this disclosure. To the extent they do not conflict with the materials, they are incorporated herein. Thus, to the extent necessary, the disclosure expressly set forth herein shall supersede any conflicting matter incorporated herein by reference. Anything, or part thereof, that is referred to herein as incorporated by reference, but that contradicts the current definitions, descriptions, or other disclosures contained herein is incorporated It shall be incorporated only to the extent that there is no contradiction between the matter and the current disclosure matter.

Embodiment
(1) A surgical instrument,
A hollow sheath including an opening, the hollow sheath defining a longitudinal axis;
A blade disposed at least partially within the hollow sheath and extending through the opening, the blade comprising a tip and a cross-sectional shape that is a polygon adjacent to the tip; A blade with a tip protruding away from the longitudinal axis;
A surgical instrument comprising: at least one ultrasonic transducer operably coupled to the blade.
(2) The surgical instrument of embodiment 1, wherein the opening defines a plane that intersects the longitudinal axis and is not perpendicular to the longitudinal axis.
(3) Embodiment 1 wherein the opening defines a first plane and a second plane intersecting the first plane, and the blade extends through the first plane. The surgical instrument described in 1.
(4) The surgical instrument according to embodiment 1, wherein the hollow sheath further includes a protective lip extending toward the tip.
(5) the blade further includes a tip that is at least 0.25 inches away from the longitudinal axis but is no more than 0.75 inches away from the longitudinal axis; The surgical instrument according to embodiment 1.
(6) the blade is curved adjacent to the tip, the blade defining a first axis within the hollow sheath and a second axis passing through the tip, the first and The surgical instrument of embodiment 1, wherein the second axis defines an angle and the angle is greater than or equal to 60 degrees but less than or equal to 90 degrees.
(7) The surgical instrument according to embodiment 1, wherein the tip has a pyramid shape.
(8) The surgical instrument according to embodiment 1, wherein the polygon is a quadrilateral.
(9) The surgical instrument according to embodiment 8, wherein the quadrilateral is a rhombus.
(10) The operation according to embodiment 9, wherein the rhombus defines an angle between a side of the rhombus and a center line of the rhombus, and the angle is not less than 10 degrees but not more than 25 degrees. Instruments.

(11) The surgical instrument of embodiment 9, wherein the rhombus comprises four vertices, two of the vertices defining an axis that is coplanar with the longitudinal axis of the blade.
(12) The surgical instrument according to embodiment 1, further comprising a suction port communicating with the hollow sheath, wherein the hollow sheath is configured to apply suction from the suction port to the opening.
(13) a surgical instrument,
A blade defining a longitudinal axis, the distal end, a lumen, a first opening adjacent to and in communication with the distal end, and above the first opening A blade comprising: a first cutting edge positioned at and projecting away from the longitudinal axis;
A suction port in communication with the lumen, wherein the blade is configured to apply suction from the suction port to the first opening; and
A surgical instrument comprising: at least one ultrasonic transducer operably coupled to the blade.
The surgical instrument of claim 13, wherein the first cutting edge defines an arc.
(15) the first opening is in a first longitudinal position on the blade, and the blade is
A second opening at the first longitudinal position, the second opening communicating with the lumen;
The surgical instrument of embodiment 13, further comprising a second cutting edge positioned above the second opening and projecting away from the longitudinal axis.
(16) The blade is
A third opening at the first longitudinal position, the third opening communicating with the lumen;
The surgical instrument of embodiment 15, further comprising a third cutting edge positioned above the third opening and projecting away from the longitudinal axis.
(17) The blade is
A second opening proximal to the first opening, the second opening communicating with the lumen;
The surgical instrument of embodiment 13, further comprising a second cutting edge positioned above the second opening and projecting away from the longitudinal axis.
The surgical instrument of claim 17, wherein the first and second cutting edges are defined by a cutting shroud.
(19) a surgical instrument,
A blade defining a longitudinal axis, wherein the blade is positioned above the first opening, a distal end, a lumen, a first opening in communication with the lumen; and A first cutting edge projecting away from the longitudinal axis; a second opening communicating with the lumen; and positioned above the second opening and projecting away from the longitudinal axis A second cutting edge, wherein the second cutting edge is proximal to the first cutting edge;
A suction port in communication with the lumen, wherein the blade is configured to apply suction from the suction port to the first opening; and
A surgical instrument comprising: at least one ultrasonic transducer operably coupled to the blade.
(20) The surgery according to embodiment 19, wherein the blade further comprises a third opening communicating with the lumen, and a third cutting edge positioned above the third opening. Instruments.

Claims (9)

A surgical instrument,
A hollow sheath including an outer periphery and an opening, the hollow sheath defining a longitudinal axis;
A blade disposed at least partially within the hollow sheath and extending through the opening, the blade comprising a tip and a cross-sectional shape that is a polygon adjacent to the tip; A blade having a tip protruding away from the longitudinal axis and extending radially beyond the outer periphery; and
A surgical instrument comprising: at least one ultrasonic transducer operably coupled to the blade ;
At least a portion of the blade extending radially beyond the outer periphery has the cross-sectional shape of the polygon;
The polygon is a diamond;
The surgical instrument, wherein the diamond comprises four vertices, and two acute vertices of the vertices define an axis that is coplanar with the longitudinal axis of the hollow sheath.   The surgical instrument of claim 1, wherein the opening defines a plane that intersects the longitudinal axis and is not perpendicular to the longitudinal axis.   The opening of claim 1, wherein the opening defines a first plane and a second plane that intersects the first plane, and the blade extends through the first plane. Surgical instruments.   The surgical instrument of claim 1, wherein the hollow sheath further comprises a protective lip extending toward the tip.   The blade further comprises a tip that is at least 0.25 inches away from the longitudinal axis, but no more than 0.75 inches away from the longitudinal axis. The surgical instrument described in 1.   The blade is curved adjacent to the tip, the blade defining a first axis within the hollow sheath and a second axis passing through the tip; the first and second The surgical instrument according to claim 1, wherein the axis defines an angle, and the angle is greater than or equal to 60 degrees but less than or equal to 90 degrees.   The surgical instrument according to claim 1, wherein the tip has a pyramid shape. It said rhombus, defines the angle between the center line of the side and the rhombus of the rhombus, the angles, but not less than 10 degrees, more than 25 degrees, surgical instrument according to claim 1.   The surgical instrument of claim 1, further comprising a suction port in communication with the hollow sheath, the hollow sheath configured to apply suction from the suction port to the opening.

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